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Medicaid and mental health coalitions find strength in numbers

Groups have in common five-year-old training program by Sunflower Foundation

By Phil Cauthon | September 17, 2013

Rick Cagan, director of the Kansas chapter of the National Alliance on Mental Illness.

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There are basic principles for how you get things done at the Kansas Statehouse, said Rick Cagan, a veteran Topeka-based mental health advocate.

One is this: "Coalitions are a fundamental fact of life.

"Very few of our organizations have the level of influence on their own necessary to move an issue through the process. So we combine our strength with like-minded organizations on different sets of issues," said Cagan, director of the Kansas chapter of the National Alliance on Mental Illness.

Cagan's organization is part of a coalition of mental health advocacy groups that this summer launched an initiative aimed at making legislators more aware of mental health issues.

It also is among the 44 members of another, larger coalition: the Kansas Medicaid Access Coalition.

"We have an interest in the expansion of Medicaid. We think it's the right policy for the state of Kansas," Cagan said.

Currently 24 states — including Kansas — are not expanding Medicaid as provided for by the Affordable Care Act, sometimes called Obamacare. When the U.S. Supreme Court upheld the law last summer, it ruled that Medicaid expansion must be optional for states, not a requirement as originally called for in the law.

Under Obamacare, the federal government will pay the full cost for new Medicaid participants through 2017, with the states incrementally picking up no more than 10 percent of costs after that. The federal government now covers about 60 percent of the cost of Medicaid, leaving the balance to the states.

Cagan said the mentally ill will be affected by Kansas not expanding Medicaid.

"Individuals with serious mental illness are disproportionately represented in the population of individuals who are not insured," Cagan said. "Not having access to health insurance creates a barrier. There are many other barriers to getting mental health treatment, but we'd like to eliminate the barrier that exists because people don't have health insurance."

Sean Gatewood

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Expansion debate 'needs to happen'

The Medicaid expansion coalition is being spearheaded by former State Reps. Sean Gatewood and Carolyn Weinhold, who are working with the Kansas Health Consumer Coalition (KHCC).

Gatewood told a recent meeting of the Kansas Mental Health Coalition that the group was collecting stories from across the state of individuals who lack health insurance so that they could be presented to legislators throughout the 2014 session.

He said the group also was distributing and collecting form letters supporting Medicaid expansion to give lawmakers and was sponsoring petition drives.

"We're trying to build like a pyramid of support for expansion...with a broad base at the bottom," Gatewood said. "We believe there is strength in numbers."

Anna Lambertson, executive director of the Kansas Health Consumer Coalition.

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Anna Lambertson, the consumer coalition's director, said Medicaid expansion could benefit 130,000 uninsured Kansans — nearly a quarter of the state's residents — and therefore legislative debate on the topic is warranted.

"We haven't yet had a discussion in the Kansas Legislature about Medicaid expansion and that needs to happen," she said. "The legislature needs to talk about this and maybe even have a vote, have a debate."

Meanwhile, Lambertson said, coalition members are working to inform legislators.

"We're working to get information to legislators and telling them this is a decision that needs to be made. Kansas keeps floating along as if that's not the case."

Legislators earlier this year passed a resolution saying the governor couldn't expand the program without "express" approval of the Legislature, but didn't tackle the issue head on.

Growing better grassroots

Lambertson said coalition building involved more than calling groups to get them to lend their names to an effort.

"Coalition building is definitely a lot more complex than just calling people. Building a coalition requires strong relationship building and intentional discussions and compromise so that the coalition members can work collaboratively to achieve mutual goals," she said. "From the name of the coalition to the talking points we use — everything is achieved through intentional discussions and a lot of work."

Lambertson and Cagan both attributed much of their success in networking, relationship building, and ultimately working to form a coalition to the same program: the Sunflower Foundation Advocacy Fellowship.

The 2009 class of the Sunflower Advocacy Fellowship Program. (STANDING L to R) Rosa Molina, Executive Director, Medical Service Bureau, Wichita; John Carney, Vice President, Aging and End of Life, Center for Practical Bioethics, Kansas City; Michael Mayberry, Executive Director, Community Health Council of Wyandotte County, Kansas City; Phelps Murdock, President and CEO, Bridging the Gap, Kansas City; Richard Cagan, Executive Director, National Alliance on Mental Illness-Kansas, Kansas City; Brian Walker, President and CEO, Kansas Food Bank, Wichita; Cathy Harding, Executive Director, Kansas Association for the Medically Underserved, Topeka; Stephanie Waggoner, CEO, United Methodist Mexican American Ministries, Garden City; and Shannon Cotsoradis, Executive Vice President and COO, Kansas Action for Children, Topeka. (SEATED L to R) Elizabeth Weeks Leonard, Associate Professor, University of Kansas School of Law, Lawrence; Kara Lineweber, Public Policy Advocate, El Centro, Inc., Kansas City; Chrysanne Grund, Project Director, Greeley County Health Services, Sharon Springs; Mitzi E. McFatrich, Executive Director, Kansas Advocates for Better Care, Lawrence; Vicki Worrell, Associate Professor, Emporia State University, Emporia; and Krista Postai, CEO, Community Health Center of Southeast Kansas, Pittsburg.

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Lambertson was a member of the 2011 class, and Cagan was in the inaugural 2009 class.

"The Sunflower fellowship program has been a wonderful network through which I have formed and strengthened crucial partnerships with other advocates across the state," Lambertson said.

Cagan said the 60 fellows who have been through the program constitute a substantial network with overlapping interests.

"The fellowship helps make connections between organizations that probably weren't working together or talking with each other prior to the experience. Over the period of four classes — and I think a fifth is getting ready to get started — there's an increasingly large cadre of folks," Cagan said.

Practical advocacy skills

He said the program — which took 12 days over the course of a year — taught practical skills such as how to systematically track bills in the Statehouse and how to avoid jeopardizing the legal status of a non-profit.

"Even old dogs can learn new tricks," Cagan said.

He said the program also was helpful in educating advocates how to deal with legislators.

"I think a lot of times they (legislators) are acting without adequate information and we (advocates) sometimes fail to find out exactly what the gaps in their information are or what their misinformation may be," he said.

'Elevating voices'

Doug Farmer — who runs the program as the Sunflower Foundation's vice president for policy — said teaching coalition-building skills was one of the core goals of the fellowship.

"The idea behind grassroots work of any type is helping to elevate the voices of people in the community who otherwise wouldn't speak up on their own. I think by focusing specifically on coalition work, the idea is to help people with similar interests recognize that if they work together on broader policy issues, they're more likely to be successful," he said.

Farmer has worked in and around state government for more than 15 years.

"From the perspective of a policymaker, when they hear from a coalition of organizations that's interested in a particular policy issue, they're more likely to engage in that conversation than they are if they only hear from one organization or one individual," he said.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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